Key clinical point: Two large studies raise doubts about previous smaller studies that had raised hopes that early use of moisturizers could prevent atopic dermatitis.
Major finding: There were no statistically significant differences in the rates of atopic dermatitis between emollient and standard skin care groups.
Study details: Two randomized, controlled trials comparing rates of atopic dermatitis after early use of emollients in infants.
Disclosures: The studies were funded by the National Institute for Health Research Health Technology Assessment (BEEP) and a range of public and private funders (PreventADALL).
The “null findings” of these two studies were “unexpected,” Kirsten P. Perrett, MBBS, Phd, and Rachel L. Peters, PhD, of the department of population allergy at Murdoch Children’s Research Institute, Parkville, Australia, wrote in an accompanying editorial. They noted that emollients are used regularly in the management of atopic dermatitis, where they help maintain the skin barrier and reduce the need for anti-inflammatory therapies.
These two large prevention studies were “prompted” by the results of small, proof-of-concept pilot studies, which “provided strong efficacy signals for the hypothesis that daily emollient use could prevent atopic dermatitis,” they wrote. But the two studies “found no evidence that daily emollient use in either a population-based or high-risk cohort of infants during the first year of life could delay, suppress, or prevent atopic dermatitis.” The lower incidence of atopic dermatitis among those in the dietary and emollient combination, compared with controls (5% vs. 8%) in PreventADALL, could be a chance finding.
The large, randomized Prevention of Eczema by a Barrier Lipid Equilibrium Strategy (PEBBLES) trial is ongoing to confirm results from a small study suggesting the efficacy of a ceramide-dominant emollient. But the PreventADALL study showed low compliance, suggesting that this intervention, if effective, a twice-daily emollient regimen may be tough to implement. “At this stage, emollients should not be recommended for the primary prevention of atopic dermatitis in infants,” they concluded.
Dr. Perrett and Dr. Peters declared no competing interests. Their comments appeared in the Lancet (2020 Feb 19. doi: 10.1016/S0140-673633174-5).